The comprehensive inspection took place on 14 February 2017 and was announced. Agape Healthcare Limited provides personal care to people in their own homes. At the time of the inspection there were two people using the service. The inspection team consisted of one inspector.

There was a registered manager in place who was present during our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

When we last inspected the service in July 2016 the provider was complaint with all the regulations but further action was required to improve the service. Records required further information about how staff were to support people to apply prescribed skin creams appropriately, the registered provider had not taken sufficient action to display their inspection ratings effectively and quality checks were not always planned ahead to foster a culture of improvement. At this inspection we found that the provider had made several improvements to the service but further action was still required.

All the people we spoke with said they felt the service kept them safe. Staff knew how to report safeguarding concerns and knew how to help keep people safe.

Care records contained information for staff about how to identify if a person’s condition was deteriorating and what action to take in order to reduce the risk of harm. The registered manager had conducted checks to ensure staff were suitable to support people.

Staff knew how to support people with creams however this guidance was not clear in people’s care records. The registered manager conducted spot checks to ensure people were supported with their medication appropriately.

People were supported by staff who had the skills and knowledge to meet their specific care needs. However there was no general information for staff about people’s conditions or how it may impact upon the people they supported.

People were supported in line with the Mental Capacity Act 2005.

People were pleased with how staff supported them to eat and drink and seek the support of health professionals when needed. Staff we spoke with were knowledgeable about people’s preferences and could give examples about how they endeavoured to support people to enjoy things they knew they liked.

People told us that they were generally happy to be supported by the service. People were involved in identifying how their care was to be provided.

People told us they felt comfortable to complain if something was not right. The registered manager had a process to review concerns and complaints at regular management meetings. When necessary they had taken effective action to prevent similar events from reoccurring.

The registered manager had systems for monitoring the quality of the service and had taken action when improvements were needed. However these systems had not identified all the concerns we recognised at the inspection such as incomplete record keeping.

We carried out an announced inspection of this service on 15 April 2016. A breach of legal requirements was found. We wrote to the provider and issued a warning notice requiring them to take action in respect of improving their systems of monitoring and managing the service.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Agape on our website at www.cqc.org.uk.hat had been noted.

We undertook an announced inspection of Agape Healthcare Limited on 14 July 2016. There were three people using the service. Agape Healthcare Limited provides personal care to people in their own homes. We reviewed how the provider had responded to our concerns from our last visit.

The provider had responded to our concerns and taken action to improve the service however further improvements were required to provide people with consistent good, safe care.

Although there was no registered manager at this location a new manager had been appointed to support the existing manager and was in the process of applying to the Commission for registration. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

The provider had displayed the ratings of their most recent inspection which meant the provider was now complying with this requirement of the regulations.

The new manager had taken action to improve the recruitment process and had introduced a structured staff training programme. This this meant that people would be supported by suitable staff who had the skills and knowledge to meet their specific care needs.

Staff had access to suitable information and guidance about how they needed to support people. The new manager had reviewed and updated people’s care plans with people’s expressed preferences and how to minimise risks associated with people’s specific conditions There was more guidance for staff about how to support people to take their medication safely and although staff knew how to apply people’s creams, this information was not clear in people’s care records.

Records showed that the existing manager had increased the frequency of their contact with people who used the service and care staff to obtain their views about the quality of the service and how to meet people’s care needs.

The new manager had introduced systems to monitor improvements and that actions were completed as planned. We noted there was no overall plan to ensure that actions and resources were coordinated effectively.

The inspection took place on 15 April 2016 and was announced. There were three people using the service and the inspection team consisted of two inspectors. The inspection was to review how the provider had responded to concerns raised at our last inspection.

At the last comprehensive inspection in September 2015 this provider was placed into special measures by CQC. Breaches of legal requirements were found. After the comprehensive inspection, we met with the provider and they also wrote to us to say what they would do to meet legal requirements in relation to breaches of regulations. We undertook this full comprehensive inspection to check they had followed their plan and to confirm they now met legal requirements. This inspection found there were enough improvements to take the provider out of special measures. The provider now met their legal requirements but further improvement was required.

Agape Healthcare Limited provides personal care to people in their own homes. At the time of this inspection the service was providing personal care to three people who lived in their own homes.

The provider had improved the process to review and assess the quality of care people required. The manager had on going regular contact with the people who use the service, reviewed care plans and acted on people’s comments. However they did not always monitor information collected and received for trends to identify how the service people received could be improved. The manager conducted audits of records to ensure they were completed and up to date. However they had not identified all gaps or errors in information.

There had been no registered manager in place since September 2014. Since that time one of the two company directors had been managing the service however a new manager had recently been recruited and told us they were going to apply to become the registered manager. The provider told us that they did not intend to take on providing care to any more people until the new manager was registered with the CQC. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were generally kept safe from the risk of harm. There was a system to report concerns about people’s safety to the appropriate authorities. Specific risks to people’s health had been identified and guidance in place in order to reduce these risks. We noted however this guidance was not always detailed or accurate. There were processes and information in place to help staff keep people safe from the risk associated with their medication.

The manager had improved the quality of the recruitment process and checking since the last inspection, but further action was needed to improve systems in use to demonstrate that recruitment checks had been completed. Some staff had commenced employment without a comprehensive induction however the manager had undertaken checks to confirm people had the qualifications and experience to meet people’s care needs. Not all documentation and risk assessments had been completed to demonstrate the action the provider had taken when they had identified risks with prospective staff or when information of concern came to light. You can see what action we have asked the provider to take at the back of the report.

People said that staff were caring and they were happy to be supported by the service. The manager had introduced a weekly process to seek people’s views of the service and ensure regularly contact with them. Staff knew how people liked to be supported.

All the people who used the service were able to say how they wanted to be supported and told us that staff respected their wishes. The new manager was able to explain the provider’s process to ensur

The inspection took place on 22 September 2015 and was announced.

At our last inspection in December 2014 the provider had breached the requirements of some of the regulations we looked at. At that time we identified that poor recruitment and training practices meant that people were at risk of being supported by staff who were not suitable. The provider had not adequately assessed the risk presented by people’s conditions and medication or provided suitable guidance for staff about how to manage these risks. The provider did not have robust systems to monitor the quality of the service or ensure that people’ care records were fit for purpose and provided staff with guidance needed. The manager and staff were unaware of their responsibilities to support people in accordance with the Mental Capacity Act. The provider had not ensured that a manager was in place who was registered with the Commission. Following the last inspection the manager submitted an action plan outlining action they intended to take. At this inspection we found that the required improvements had not been made in line with the plan submitted and compliance with the regulations had not been achieved.

The service provided personal care to 11 people who lived in their own homes. There had been no registered manager in place since September 2014. Since that time one of the company directors had been managing the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were at risk of receiving unsafe care and support. The manager had not notified the local safeguarding authority when they thought people were at risk of harm. Risks to people were not managed appropriately to keep them safe from harm.

When people needed support to take their medication, there was no clear guidance about how staff were to provide this safely. We found that there was no information for staff about people’s medications or any risks they presented.

The manager had failed to ensure that robust recruitment checks were undertaken. Some staff had been employed without adequate measures in place to ensure that people received care from properly recruited and skilled staff. Some staff had commenced employment without a comprehensive induction and the manager was unaware of what training individual staff had completed.

People said that staff were caring and they were happy to be supported by the service. However, the manager had no formal process to seek people’s views of the service or have regular contact with them. People were limited in how much they could influence and be involved in developing the service or in expressing how wanted their care to be delivered.

The manager and staff we spoke with were not knowledgeable about how to protect and promote people’s legal rights in line with legislation. People were at risk of having decisions made about their care by people who did not have the legal authority to do so.

The processes in place to identify if people were at risk from not eating or drinking sufficient amounts were not effective and relied on information being passed verbally between staff. Records were not maintained when people needed support to receive the appropriate nutrition to keep them well.

The provider did not have robust processes for monitoring and improving the quality of the care people received. There were no processes in place to improve the service or enable the manager to identify if care was delivered in line with people’s care needs and wishes.

Resources required to run the service were not always available. The manager told us they could not afford to finance training or pay some staff the minimum wage. They had not made any plans to ensure the service did not breach the relevant legislation or how they would continue to support people who used the service if staff chose to leave.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

This inspection took place on 16 December 2014 and was announced. We gave the provider 48 hours notice that we intended to inspect the service. This allowed the provider time to collect information about the care people received in their homes which we might have wanted to review.

Agape Healthcare Limited is a domiciliary care agency which provides personal care to people in their own home. At the time of our inspection six people were receiving personal care from the service. There was a manager at this location however they were not registered with us. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At our last inspection in June 2014, we found that the provider had breached regulations relating to how people at the service were supported and kept safe. They had also breached regulations relating to how they monitored the quality of the service and record keeping. The provider sent us an action plan to tell us the improvements they were going to make to ensure the service would comply with the regulations. At this inspection we found that the provider had not completed all actions that they had promised. We saw that the provider had reviewed some care plans and updated risk assessments but had still not taken sufficient action to meet the appropriate regulations. You can see what action we have told the provider to take at the back of the full version of this report.

The provider did not have robust systems to monitor the quality of the care provided or identify, assess and manage risks relating to the health and welfare of people who used the service. The provider did not have a robust system to review the quality of the service. The provider had not ensure that new staff were recruited in line with their policies or ensure that staff had the skills and knowledge to safeguard the health, safety and welfare of the people who used the service. The provider had failed to take suitable action in response to our last inspection and we found that some of the concerns raised were still unresolved. You can see what action we have told the provider to take at the back of the full version of this report.

People who used the service told us that they were confident that care was provided in accordance with their needs. Four people who used the service and three members of staff who we spoke with, all told us that they felt people at the service were safe. However peoples care records did not always contain information and guidance staff required to ensure they supported people safely. Information about people’s specific conditions and how they were to be supported was not always transferred when assessments were updated.

The provider did not have a robust recruitment process to check if staff were suitable to support people. The relatives of two people who used the service told us they felt their relatives were safe and that staff understood their needs however records showed that the provider had not followed up gaps in staff employment history or obtain independent references to identify if staff were fit to support people. You can see what action we have told the provider to take at the back of the full version of this report.

People told us that they felt confident staff supported them to take medication safely however records did not always contain clear guidance for staff to follow which could result in medicines not being administered safely. The provider had not taken action when they identified that staff required training in how to support people to take their medication safely.

People who used the service and their relatives told us that they felt there were enough care staff to meet people’s care needs and that they were consistently supported by the same staff members. This had helped people to build up close relationships with the care staff who provided their personal care.

Records showed that the provider had mostly recruited staff that had previous experience and qualifications in social care. However, not all staff had undertaken induction or training to address gaps identified in their skills and knowledge. You can see what action we have told the provider to take at the back of the full version of the report.

All the people we spoke with said that they were supported in line with their care plans. The relative of a person who lacked capacity told us that they were regularly approached by care staff or the manager to discuss how care was to be delivered. The manager and staff were unsure about their responsibilities in ensuring people were supported in line with the Mental Capacity Act 2005. Staff had not received training to help them understand their responsibilities. You can see what action we have told the provider to take at the back of the full version of the report.

People were able to express any concerns about the service they received. However several people told us that the manager did not always respond promptly to concerns raised. We saw that action was not always taken when it was identified that people’s care needs had changed.

The provider had not responded to all the concerns we raised at our last inspection. We saw that the provider’s systems for monitoring the quality of the service and staff training were still in breach of current regulations. The manager had not identified errors and omissions in care records or poor recruitment and training practices. The provider did not have a system to record concerns or learn from untoward incidences.

The inspection was undertaken by one inspector. We gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led? At the time of our inspection two people were receiving care. We spoke with relatives of both people who used the service, the manager and three members of staff.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

We spoke to relatives of two people who used the service. They told us that they felt their relatives were safe when being supported by care staff.

People told us that care staff knew how to care for them. We spoke with care staff and looked at records. Staff were able to explain people’s specific care needs. However care records were not properly organised and did not always contain information on how staff should support people who were at risk of not taking their medication to do so.

Staff received training in how to use equipment so people were kept safe from harm. Staff had not received robust safeguarding training. Staff we spoke to were unable to explain the principles of safeguarding or external agencies they could refer safeguarding concerns to. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring that care staff have sufficient knowledge in order to keep people safe from the risk of harm.

Is the service effective?

Where necessary, risk assessments had been undertaken and were used to help staff provide appropriate, safe and consistent support to people who used the service.

People who used the service were asked to comment on the service provided, this included questions about the support they received.

People’s health and care needs had been reviewed with them. We saw that care records were updated as people’s needs changed. Care plans contained information and guidance about people’s specific conditions. However, there were not always assessments about the risks of people not taking their medications. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring that care records contain appropriate information for staff to meet people’s care needs and how to respond to risks when people did not want their planned care and support.

Is the service caring?

All the people we spoke to confirmed that staff were kind to them. Comments included: “The staff are very good” and “We are happy with the service”.

When speaking with staff it was clear that they genuinely cared and knew about the people they were supporting. People’s preferences, interests, aspirations and diverse needs had been recorded and support had been provided in accordance with people’s wishes.

Is the service responsive?

People were supported to comment on the care they received at regular meetings. People told us that the provider made them feel comfortable to raise concerns. We saw that the provider responded appropriately to concerns so that the service could improve. A relative of a person who used the service told us, “I don’t have any concerns.”

The provider had a complaints policy which showed people how to make a complaint if they were unhappy. The manager was aware of the provider’s policy and knew how to respond to concerns. People told us that they had copies of the provider’s complaints policy in their homes but had not needed to raise a complaint.

Is the service well-led?

The provider regularly sought the views of the people who used the service. We saw evidence that they had introduced changes to how people were supported in response to comments received. A person told us, “They [the manager] are pleasant and approachable.”

There was evidence that the provider had ensured that learning from incidents took place and appropriate changes were introduced or implemented to keep the people safe from harm. We saw that the provider had reviewed their staffing rota in response to concerns. But the provider had not responded to all the concerns we raised at a previous inspection.

The manager and staff told us they did not hold meetings or supervisions with staff to discuss quality issues to ensure that people received a good quality service at all times.

The provider conducted spot checks to assess the quality of the care being delivered in people’s homes however these were ad-hoc. The service did not have a robust quality assurance system to review the quality of the service. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring that they regularly assess and monitor the service in order to protect people against the risk of inappropriate or unsafe care and treatment.

This was the first inspection since providing the regulated activity. When we visited the service was providing personal care to seven people in their own homes. We used a number of methods to understand the experiences of the people who used the service. We spoke to one person and the relatives of three people who used the service. We also spoke to the registered manager, a manager in the office, and two care staff. We looked at records and spoke to a social worker who supported a person who used the service. The registered manager was not present for the majority of the inspection and delegated responsibility for the inspection to the manager in the office.

We saw that some entries in care records were not respectful to people or protected their dignity.

The care provided was not always planned, designed or delivered as agreed to meet people’s individual care needs.

The provider had not made suitable arrangements to ensure that people using the service were guarded against the risk of abuse.

There were not always enough care workers who were skilled, qualified and competent to provide people with the care they required.

The provider did not protect people from the risk of receiving unsafe care because they did not regularly assess and monitor the quality of the service provided.

The provider did not have a robust system to deal with complaints because they did not bring the system to people’s attention or resolve complaints to people’s satisfaction.